Diagnostic and prognostic implications of bacteremia in patients with complicated pleural infection

Chang Ho Kim, Ji Eun Park, Jung Guen Cha, Jae Kwang Lim, Jongmin Park, Yong Hoon Lee, Sun Ha Choi, Hyewon Seo, Seung Soo Yoo, Shin Yup Lee, Seung Ick Cha, Jae Yong Park, Jaehee Lee

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The clinical significance of bacteremia in patients with complicated pleural infection is still uncertain. We aimed to examine the incidence and clinical significance of bacteremia in patients with complicated pleural infection. Methods: This retrospective study comprised of consecutive patients who received pleural drainage due to complicated parapneumonic effusion or empyema. The clinical, laboratory, and radiologic data and clinical outcome were compared between patients with and without bacteremia. Additionally, the factors associated with overall mortality were evaluated in these patients. Results: Of 341 patients included in the analysis, 25 (7%) had a positive blood culture. Blood culture testing added 2% identification of causative pathogen compared to pleural fluid culture alone. By multivariable analysis, radiologic features of cavitary lesion, a RAPID score≥5, and a positive microbial culture in pleural fluid were independently associated with bacteremia. Despite these clinical distinctions, there was ultimately no significant difference in in-hospital mortality between patients with and without bacteremia (3 vs. 4%, p=1.0). The only factor significantly associated with overall mortality among patients with complicated pleural infections was a higher RAPID score [HR=1.96 (95% CI=1.35-2.84)]. Conclusions: The rate of bacteremia in patients with complicated pleural infection was 7%. Blood culture testing demonstrated limited diagnostic yield and had minimal impact on clinical outcomes compared to pleural fluid culture. Therefore, it seems that blood culture testing is more advantageous for specific patients with suspected pleural infection who have cavitary lesions or a RAPID score≥5.

Original languageEnglish
Pages (from-to)55-61
Number of pages7
JournalPleura and Peritoneum
Volume9
Issue number2
DOIs
StatePublished - 1 Jun 2024

Keywords

  • bacteremia
  • empyema
  • microbiology
  • outcome
  • pleural infection

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